If you are aware of infants who have already been diagnosed with CMPA, take the time to speak to the parents about how they are coping with the condition and if there has been any improvement in symptoms. It has been suggested that infants with diagnosed CMPA should remain on a cows’ milk protein-free diet until nine to 12 months of age and for at least six months prior to the reintroduction of cows’ milk into their diets,⁸ so parents may need your support during this time.

CMPA can present in exclusively breastfed infants but is much more rare than in formula fed infants. If diagnosed, this usually requires dietetic advice to completely exclude all sources of cows' milk protein from the mother's diet. Breastfeeding should then continue and be supported for as long as the mother wishes by ensuring that she has the guidance needed to commence a varied dairy-free diet.⁷ In exclusively breastfed infants, a specialist formula may therefore not be necessary; however, it is essential in infants and younger children who are fully or partially formula fed.⁴

There are three types of formula that may be prescribed:

1.

Extensively hydrolysed cows’ milk protein-based formula (eHF) – first-line option for infants and young children with mild to moderate symptoms (e.g. colic, reflux, diarrhoea, vomiting, eczema) in the absence of faltering growth.⁸

 

2.

Amino acid-based formula (AAF) – first-line option for infants and young children with severe symptoms such as those with a history of anaphylaxis and severe GI symptoms, particularly in association with faltering growth.⁸

 

3.

Soy-based formula (SF) €“ may be used for babies from 6 months with cows' milk protein allergy when soya is being used/considered for the weaning diet. Although not routinely recommended for infants under 6 months old, it may be used in babies younger than 6 months who refuse extensively hydrolysed milk, vegan mothers, and infants with galactosaemia.*⁸

_{*If not sensitised to soya on IgE testing.}